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PubMed2002

Percent prostate needle biopsy tissue with cancer is more predictive of biochemical failure or adverse pathology after radical prostatectomy than prostate specific antigen or Gleason score.

PURPOSE: Biopsy Gleason score, serum prostate specific antigen (PSA) levels, and clinical stage are known to be independent predictors of adverse pathological features and biochemical failure after radical prostatectomy. We determine whether various prostate needle biopsy parameters were predictive of either adverse pathological findings or disease recurrence after radical prostatectomy. MATERIALS AND METHODS: A single pathologist reviewed the prostate needle biopsy specimens of 190 men who underwent radical prostatectomy between 1991 and 2000. Biopsy specimens were examined for Gleason score, perineural invasion, number and percent of cores with cancer, and percent of total biopsy tissue with cancer and Gleason grade 4 or 5 cancer. Multivariate analysis was used to determine the prostate needle biopsy parameters and preoperative clinical variables, including serum PSA, clinical stage, patient age and race, that were most significant for predicting positive surgical margins, nonorgan confined disease, seminal vesicle invasion and biochemical failure after radical prostatectomy. RESULTS: Of the prostate needle biopsy parameters examined percent of tissue with cancer was the strongest predictor of biochemical recurrence in the multivariate analysis (p <0.001). Percent of tissue with cancer was a stronger predictor of biochemical recurrence than either PSA (p = 0.048) or biopsy Gleason score (p = 0.053). It was also a strong independent predictor of seminal vesicle invasion (p = 0.015) and nonorgan confined disease (p = 0.024). Perineural invasion, percent and number of cores with cancer, and percent of tissue with Gleason grade 4 or 5 were not independent predictors of either adverse pathology or biochemical failure. CONCLUSIONS: Of all the preoperative variables examined, including the standard clinical variables of serum PSA, Gleason score and clinical stage, percent of biopsy tissue with cancer was the strongest predictor of biochemical recurrence, seminal vesicle invasion and nonorgan confined disease. Consideration should be given to reporting percent of total biopsy tissue with cancer in all prostate biopsy results.

Aged↗
PubMed2002

A technique of bladder neck closure combining prostatectomy and intestinal interposition for unsalvageable urethral disease.

PURPOSE: We describe a technique of bladder neck detachment and augmented closure incorporating total prostatectomy and urinary diversion in men with complex bladder and urethral pathology due to fistula, radiation and neurogenic dysfunction. MATERIALS AND METHODS: We retrospectively reviewed the records of 5 men 38 to 61 years old who presented with unsalvageable urethral pathology, including prostate cancer in 2. All 5 patients underwent radical prostatectomy and augmented bladder neck closure with creation of a continent catheterizable stoma in 4 and chimney diversion in 1. RESULTS: Bladder neck closure was performed with interposition of an ileocecal patch in 4 cases and sigmoid colon in 1. At a mean followup of 6 months no fistula, recanalization or urinoma developed. Delayed complications included stomal stenosis, stomal incontinence requiring collagen injection and rupture of the augmented bladder in 1 case each. The 2 men with prostate cancer had undetectable prostate specific antigen. CONCLUSIONS: Prostatectomy facilitated mobilization of the bladder neck away from the urethral pathology and interposition of an intestinal segment at the bladder neck allowed healing. In addition to cases of complicated urethrovesical pathology, this technique may have applications in salvage prostatectomy after pelvic irradiation for carcinoma.

Adult↗
PubMed2002

Serum levels of insulin-like growth factor-1 and insulin-like growth factor-1 binding proteins after radical prostatectomy.

PURPOSE: Elevated serum levels of insulin-like growth factor-1 (IGF-1) have been consistently shown to be a risk factor for prostate cancer. Alterations in serum IGF-1 binding proteins 1 to 3 have also been associated with prostate cancer risk. A potentially important complication in these studies is that prostate tissue, perhaps especially malignant prostate tissue, may secrete IGF-1 and its binding proteins into serum. In fact, it is possible that altered levels of these proteins observed in subjects at risk for prostate cancer are the result of prostate cancer rather than related to its cause. MATERIALS AND METHODS: The contribution of prostate cancer to serum levels of IGF-1 and IGF-1 binding proteins was determined by analyzing serum samples from 86 patients with prostate cancer 2 weeks before and 8 weeks after radical prostatectomy. Preoperative and postoperative values for IGF-1 and its 3 major binding proteins were analyzed using univariate and multivariate analysis models. RESULTS: On univariate analysis significant increases and not decreases in IGF-1, IGF binding protein-1 and 3 were observed after prostatectomy. On multivariate analysis a significant post-prostatectomy increase was observed for IGF-1 binding proteins 1 and 3 but the increase in IGF-1 was not significant. CONCLUSIONS: Increased levels of IGF-1 and IGF-1 binding proteins were unexpected after prostatectomy. This result makes it extremely unlikely that secretion from the prostate, even if it contains cancer, affects serum levels of these proteins. The implication of these findings is that endocrine production of IGF-1 is a factor in prostate cancer risk. Therefore, strategies to lower serum IGF-1 may be potentially useful.

Adult↗
PubMed2002

A randomized controlled trial comparing transurethral resection of the prostate, contact laser prostatectomy and electrovaporization in men with benign prostatic hyperplasia: urodynamic effects.

PURPOSE: We compared urodynamic and uroflowmetry improvements in men with lower urinary tract symptoms suggestive of benign prostatic hyperplasia (BPH) after transurethral prostate resection, contact laser prostatectomy and electrovaporization. MATERIALS AND METHODS: A prospective randomized controlled trial was performed in men with lower urinary tract symptoms suggestive of BPH who met the criteria of the International Scientific Committee on BPH, had a prostate volume of between 20 and 65 ml., and a Schäfer obstruction grade of 2 or greater. Before and 6 months after treatment urodynamics and free uroflowmetry were performed. RESULTS: A total of 50, 45 and 46 men were randomized to transurethral prostate resection, laser treatment and electrovaporization, respectively. Baseline characteristics were similar in the 3 groups. Detrusor contractility did not change in any of the treatment groups. The average maximum free flow rate increased by a factor of 2.4 after transurethral prostate resection, 2.5 after laser prostatectomy and 2.4 after electrovaporization. The Schäfer obstruction grade decreased by a factor of 0.3 in all groups. Obstruction (Schäfer grade greater than 2) was not noted after transurethral prostate resection or electrovaporization but it was evident in 2 patients after laser prostatectomy. Effective capacity increased by a factor of 1.5 or more. The incidence of detrusor instability was decreased by half in all groups. The incidence of significant post-void residual urine volume decreased in all groups. CONCLUSIONS: There were no significant differences in the improvement in urodynamic and uroflowmetry parameters 6 months after treatment when comparing transurethral prostate resection, contact laser prostatectomy and electrovaporization in men with lower urinary tract symptoms suggestive of BPH.

Aged↗
PubMed2000

Laparoscopic radical prostatectomy: the Montsouris experience.

PURPOSE: We evaluate our experience with laparoscopic radical prostatectomy. MATERIALS AND METHODS: Between February 1, 1998 and May 1, 1999, 120 consecutive patients underwent laparoscopic radical prostatectomy. Morbidity of the first 40 (group 1), next 40 (group 2) and last 40 (group 3) procedures was compared. Oncological data were assessed by pathological examination and postoperative prostate specific antigen (PSA). Functional results were assessed by a self-administered questionnaire for the first 60 patients and potency was assessed in the last 40. RESULTS: Mean operating time plus or minus standard deviation was 239+/-59 minutes (range 150 to 450) for the series, and 282, 247 and 231, respectively, for groups 1, 2 and 3. Surgical conversion was necessary in 7 cases (5.8%) overall, including 10% (4) in group 1, 7.5% (3) in group 2 and 0% in group 3. Mean intraoperative bleeding was 402+/-293 ml. (range 50 to 1,500) in the series, and 534, 517 and 277, respectively, for groups 1, 2 and 3. The transfusion rate was 10% overall, and 15%, 12.5% and 2.5%, respectively, in groups 1, 2 and 3. The reoperation rate was 1.7%. Mean postoperative bladder catheterization time was 6.6+/-2.4 days. The positive and questionable surgical margin rate was 15%. Pathological tumor stage was pT2a in 4 specimens (11%), pT2b in 11 (16%), pT3a in 0 and pT3b in 3 (50%) with positive surgical margins. PSA assays were available in 94 patients with a mean postoperative followup of 2.2 months (range 1 to 12). Serum PSA was 0.1 ng./ml. or less in 89 men (94.7%). The continence rate at 6 months postoperatively was 72% among the first 60 patients. Of 20 group 3 patients who were sexually active preoperatively 9 (45%) reported postoperative spontaneous erections. The overall cost of retropubic radical prostatectomy was about $1,237 more than that for laparoscopy. CONCLUSIONS: Laparoscopic radical prostatectomy is feasible and perioperative morbidity is low. Based on our postoperative followup, oncological results are identical to those of conventional surgery and functional results are encouraging.

Aged↗
PubMed2006

A pilot study of the liposomal MUC1 vaccine BLP25 in prostate specific antigen failures after radical prostatectomy.

PURPOSE: Men with biochemical failure after radical prostatectomy have few therapeutic options other than androgen deprivation therapy. Targeted therapies in this group are appropriate because the optimal timing of the initiation of hormonal therapy in this patient population is unknown. A single institution pilot trial was performed using BLP25 liposome vaccine in hormone naïve patients with prostate specific antigen failure after radical prostatectomy to determine if prostate specific antigen progression could be halted. MATERIALS AND METHODS: Men with biochemical failure after radical prostatectomy were enrolled. Primary end points were efficacy and safety of the MUC1 BLP25 liposomal vaccine. Changes in prostate specific antigen doubling time were also evaluated. Patients received a single intravenous dose of cyclophosphamide, followed by vaccinations with BLP25 liposome vaccine for up to 1 year. Prostate specific antigen was measured at baseline and during treatment, and prostate specific antigen doubling time was calculated for these intervals. RESULTS: A total of 16 patients with a median age of 60 years were enrolled. All patients received cyclophosphamide and 15 of 16 completed the primary treatment period. Ten patients completed the maintenance period. After the 8-week primary treatment period 8 of 16 patients had stable or decreased prostate specific antigen. At the last on-study prostate specific antigen measurement 1 patient maintained stable prostate specific antigen but all others had progression. However, 6 of the 16 patients had greater than 50% prolongation of prostate specific antigen doubling time compared to pre-study prostate specific antigen doubling time. CONCLUSIONS: BLP25 liposome vaccine shows promise for prolonging prostate specific antigen doubling time in hormone naïve men with biochemical failure after prostatectomy and little morbidity. This could potentially translate into the deferral of hormonal therapy. Further testing in this population of patients is warranted.

Aged↗
PubMed2006

Nerve sparing open radical retropubic prostatectomy--does it have an impact on urinary continence?

PURPOSE: We prospectively assessed the role of nerve sparing surgery on urinary continence after open radical retropubic prostatectomy. MATERIALS AND METHODS: We evaluated a consecutive series of 536 patients who underwent open radical retropubic prostatectomy with attempted bilateral, unilateral or no nerve sparing, as defined by the surgeon, without prior radiotherapy at a minimum followup of 1 year with documented assessment of urinary continence status. Because outlet obstruction may influence continence rates, its incidence and management was also evaluated. RESULTS: One year after surgery 505 of 536 patients (94.2%) were continent, 27 (5%) had grade I stress incontinence and 4 (0.8%) had grade II stress incontinence. Incontinence was found in 1 of 75 (1.3%), 11 of 322 (3.4%) and 19 of 139 patients (13.7%) with attempted bilateral, attempted unilateral and without attempted nerve sparing, respectively. The proportional differences were highly significant, favoring a nerve sparing technique (p <0.0001). On multiple logistic regression analysis attempted nerve sparing was the only statistically significant factor influencing urinary continence after open radical retropubic prostatectomy (OR 4.77, 95% CI 2.18 to 10.44, p = 0.0001). Outlet obstruction at the anastomotic site in 33 of the 536 men (6.2%) developed at a median of 8 weeks (IQR 4 to 12) and was managed by dilation or an endoscopic procedure. CONCLUSIONS: The incidence of incontinence after open radical retropubic prostatectomy is low and continence is highly associated with a nerve sparing technique. Therefore, nerve sparing should be attempted in all patients if the principles of oncological surgery are not compromised.

Aged↗
PubMed1994

Cancer control and quality of life following anatomical radical retropubic prostatectomy: results at 10 years.

The experience after 10 years with anatomical radical retropubic prostatectomy at The Johns Hopkins Hospital is reviewed. Between April 1982 and March 1991, 955 men with clinically localized prostate cancer (clinical stages T1 to T2) underwent staging pelvic lymphadenectomy and anatomical radical retropubic prostatectomy. Using actuarial analysis, at 10 years the likelihood of an undetectable prostate specific antigen (PSA) level was 70%, isolated elevation of PSA 23%, distant metastases 7% and local recurrence 4%. The actuarial likelihood of an elevated serum PSA increased with increasing pathological stage: the 10-year likelihood of freedom from PSA relapse was 85% for men with organ confined disease, 82% with focal capsular penetration, 54% with established capsular penetration and Gleason score 2 to 6 disease, 42% with established capsular penetration and Gleason score 7 to 10 disease, and 43% with seminal vesicle involvement. These data indicate that radical prostatectomy cures the majority of men with organ confined disease or with well to moderately well differentiated tumors that have penetrated the prostatic capsule to the extent where it is possible to obtain a clear surgical margin. Radical prostatectomy should be reserved for patients who can be cured and who will live long enough to benefit from it. These are also the patients who have the best quality of life postoperatively.

Actuarial Analysis↗
PubMed1994

Long-term (15 years) results after radical prostatectomy for clinically localized (stage T2c or lower) prostate cancer.

To provide information about long-term outcome after radical prostatectomy for clinically localized prostatic cancer (stage T2c or lower), we undertook a retrospective analysis of 3,170 consecutive patients (mean age 65.3 +/- 6.4 years, range 31 to 81) with a mean followup of 5 years. Complication rates for patients who underwent prostatectomy before 1988 were compared with those who underwent radical prostatectomy more recently. Of the patients 49 (1.5%), 178 (5.6%), 897 (28%) and 2,047 (65%) had clinical stages T1a, T1b, T2a and T2b,c disease, respectively. The Gleason score was 3 or less in 292 patients (9%) and 7 or greater in 782 (25%). Overall, 438 patients (14%) died, 159 (5%) of cancer. The crude 10 and 15-year survival rates for all patients were 75% and 60%, respectively, which is comparable to the expected survival of a control group (67% and 46%). The cause specific survival rates were 90% and 82%, respectively, metastasis-free survival rates 82% and 76%, local recurrence-free survival rates 83% and 75%, overall recurrence-free rates 72% and 61%, and overall recurrence plus prostate specific antigen progression-free (greater than 0.2 ng./ml.) rates 52% and 40%, respectively. Clinical stage did not significantly affect survival but tumor grade was associated: 10 and 15-year cause specific survival rates were 95% and 93%, respectively, for a Gleason score of 3 or less, 90% and 82%, respectively, for a score of 4 to 6, and 82% and 71%, respectively, for a score of 7 or more. Of all patients 26% received adjuvant treatment (hormonal and/or radiation) within 3 months postoperatively because of advanced local pathological stage (pT3 or higher) or margin positive disease. The 30-day mortality rate was 0.3% (0% for 1,728 patients who underwent surgery in 1988 or later). Only 1 patient in the 70 year or older age group died during hospitalization. Complications decreased with time. In a contemporary group the complications were rectal injury in 0.6% of the patients, colostomy in 0.06%, myocardial infarction in 0.4%, deep venous thrombosis in 1.1%, pulmonary embolism in 0.7% and total urinary incontinence (3 or more pads per day) in 0.8%. Recent intraoperative blood loss was a median of 600 ml., and the incidence of recent need for any transfusion was 31% and it is presently less than 5%. In this series patients undergoing radical prostatectomy for clinically localized prostate cancer were usually healthy and, thus, had low co-morbidity. Survival rates at 10 and 15 years compare favorably with those of an age-matched control group.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1993

Tubularized neourethra following radical retropubic prostatectomy.

A 1.5 cm. tubularized neourethra was formed using an anterior bladder flap as part of bladder neck reconstruction after radical retropubic prostatectomy in 69 consecutive patients with clinically localized prostate cancer (study group). Postoperative continence (defined as requiring no protection for any activity) was assessed by history at 3 months (all men) and 6 months (45 of 69 men). Continence in the study group was compared to that of 45 men with 6 months of followup who underwent radical retropubic prostatectomy without tubularization of the anterior bladder (control group). At 3 months 38 of 69 men (55%) were continent in the study group and 14 of 45 (31%) were continent in the control group (p < 0.03). At 6 months 39 of 45 men (87%) were continent in the study group compared to 21 of 45 (47%) in the control group (p < 0.01). Upright cystograms performed on men with and without the tubularized neourethra after radical retropubic prostatectomy suggest that a neourethra proximal to the external sphincter may increase resistance in this area and result in early return of urinary control in men undergoing radical retropubic prostatectomy.

Aged↗
PubMed1993

Possible mechanism for seeding of tumor during radical prostatectomy.

Prostatic adenocarcinoma sometimes recurs locally in the operative bed after radical prostatectomy. Having observed local recurrence in several patients who had a small tumor confined to the prostate on whole mount serial sections, we postulated that some instances of local recurrence could arise from malignant cells shed in prostatic secretions expressed during surgery. To evaluate whether prostatic secretions contain malignant cells and to estimate the frequency of this phenomenon, we collected fresh prostatic secretions from radical prostatectomy specimens immediately after removal. The secretions were analyzed by cytology for the presence of malignant cells. Of 76 samples collected from consecutive patients with clinical stages T1 and T2 prostate cancer at 3 institutions 11 (14%) contained malignant cells. Positive cytology results were most frequent in patients with poorly differentiated tumors. Of 11 cancers with a Gleason sum of 8 to 10 in the prostatectomy specimen 6 (55%) had a positive cytology result. However, of 63 tumors with a Gleason sum of 5 to 7 only 4 (6%) were positive (p < 0.0001). There was no significant correlation with either clinical or pathological stage of the tumor in this small series. Our findings suggest that malignant cells shed during prostatectomy may seed the surgical bed and could be responsible for some instances of local tumor recurrence. The rate of positive cytology results in our study is similar to the local recurrence rates reported in the literature. Surgeons should make prudent attempts to avoid seeding from this source.

Adenocarcinoma↗
PubMed1993

Analysis of risk factors associated with prostate cancer extension to the surgical margin and pelvic node metastasis at radical prostatectomy.

We analyzed data from 107 consecutive patients with clinical stage B prostate cancer in an attempt to identify those at high risk for having involved margins or nodal metastasis. Each patient underwent transrectal ultrasound-guided sextant biopsies of the prostate. Patient age, surgical approach to prostatectomy, pre-biopsy prostate specific antigen (PSA) level, and number, location and maximum Gleason score of positive biopsies were statistically evaluated for all patients groups. Prostate volume and PSA density (PSAD) were calculated for all patients undergoing prostatectomy. Of the 101 patients who underwent radical prostatectomy 64 had negative margins, 37 had at least 1 positive margin and 11 of the 37 had more than 1 positive margin. Involved margins were most common at the apex (62%) and mid portion (59%) of the gland. Prostatectomy was not performed on 6 patients with nodal metastases evident on frozen section examination. Therefore, 43 patients are considered to be at high risk for having residual disease after surgery. The mean PSAD, PSA level and number of positive biopsies were significant (p < 0.05) predictors of tumor extension to the surgical margin. The mean number of positive biopsies, biopsy Gleason score and PSA level were significantly greater (p < 0.05) in patients with nodal metastases. Only 15% of the patients with a single positive biopsy had positive margins versus 47% of those with multiple positive biopsies (p < 0.05). Of the patients with tumor positive nodes on frozen section 67% had 5 or more positive biopsies, whereas only 9% of all others had that many positive biopsies (p < 0.05). The number of positive biopsy sites, PSAD and PSA level were significantly associated with tumor at the surgical margin or metastatic to the pelvic nodes.

Adenocarcinoma↗
PubMed1993

Early detection of residual prostate cancer after radical prostatectomy by an ultrasensitive assay for prostate specific antigen.

We evaluated the usefulness of an ultrasensitive immunoassay for prostate specific antigen (PSA), modified from the standard Yang Pros-Check PSA test and with a biological detection limit for PSA in serum of 0.07 ng./ml., to detect residual prostate cancer at an earlier date. We studied retrospectively serial frozen serum samples from 22 prostate cancer patients after radical prostatectomy who later had residual cancer with detectable PSA levels of 0.3 ng./ml. or more by the standard PSA test. As controls we studied 33 cystoprostatectomy patients (for bladder cancer) without histological evidence of prostate cancer and 23 patients after radical prostatectomy who had the highest probability of cure of the cancer. All control patients without cancer had PSA values (282 of 283 samples, 99.6%) of less than 0.1 ng./ml. This value was called the residual cancer detection limit. In the 22 patients with recurrent cancer the ultrasensitive assay detected cancer recurrence (PSA 0.1 ng./ml. or more) much earlier (median 202 and mean 310 days) than the standard assay (PSA 0.3 ng./ml. or more). On screening 187 current post-radical prostatectomy patients without evidence of cancer by the standard assay the ultrasensitive assay detected 21 (11.2%) with evidence of residual cancer, that is PSA level of 0.1 ng./ml. or more. We conclude that an ultrasensitive assay for PSA can detect residual cancer after radical prostatectomy much earlier than current immunoassays for PSA. Earlier detection of residual cancer may improve long-term survival by allowing for earlier institution of adjuvant therapy.

Aged↗
PubMed1993

Invasion of Denonvilliers' fascia in radical prostatectomy specimens.

Denonvilliers' fascia consists of a single fibromuscular structure covering the posterior aspect of the prostate and surrounding the seminal vesicles. This structure has multiple layers that are fused together, and to the stroma of the prostate and seminal vesicles. A separate posterior layer of Denonvilliers' fascia was not seen during radical prostatectomy. The cleavable interprostatorectal plane extends posteriorly throughout the thickness of Denonvilliers' fascia and anteriorly to the muscular wall of the rectum. Medially this fascia is fused with the prostatic capsule into a single sheath and contains thick smooth muscle bundles in continuity with the prostatic stroma. In a series of 243 radical prostatectomy specimens for prostate cancer, we studied the morphological relationship of Denonvilliers' fascia with the prostatic capsule and stroma, and traced the progression of prostatic cancer in relation to the anatomical landmarks. In 19% of the cases tumor was found progressing within Denonvilliers' fascia, in the medial posterior area of the prostate, unrelated to perineural space invasion. For specimens with an intracapsular cancer volume of less than 12 cc, which may be cured by radical prostatectomy alone, the frequency of invasion of Denonvilliers' fascia was 13%. In these cases cephalad progression of cancer was seen almost exclusively in Denonvilliers' fascia overlying the central zone at the prostate base and surrounding the seminal vesicles. Invasion of Denonvilliers' fascia can lead to positive surgical margins if complete excision of this fascia is not performed during radical prostatectomy. Even among large tumors in our series there were no cases of tumor invasion completely through the full thickness of Denonvilliers' fascia at the posterior medial area and, therefore, rectal wall invasion was never suspected at this level.

Adenocarcinoma↗
PubMed1992

Radical prostatectomy and exenterative procedures for local failure after radiotherapy with curative intent: comparison of outcomes.

During the last 2 decades 62 patients without evidence of distant disease underwent salvage surgery, including radical prostatectomy in 32, anterior exenteration in 23 and total exenteration in 7. Mean followup was 3.7 years, mean radiation dosage was 6,083 cGy. (range 3,060 to 7,400) and interval from irradiation to surgery was 6 to 98 months (mean 48 months). The 5-year nonprogression and cause-specific survivals for radical prostatectomy patients of 82% and 90%, respectively, were significantly (p = 0.0062) better than for patients having exenterative procedures. Despite the more extensive local procedure for larger tumors used in exenteration, the residual cancer rate was higher and local control was not improved. Median time to progression after radical prostatectomy and exenterative procedures was 7.5 and 1.3 years, respectively. Progression and cancer death were related to aneuploid status and, in particular, to hormonal treatment and its timing, with the best results obtained when adjuvant hormonal treatment was used for nonaneuploid tumors. Complications were more frequent than after primary prostate surgery. Salvage exenterative procedures seem to be of questionable benefit because of rapid disease progression. Prostatectomy, if feasible, appears to be an acceptable treatment for these difficult cases.

Aged↗
PubMed1989

Continence following nerve-sparing radical prostatectomy.

Urinary incontinence after radical prostatectomy is a difficult postoperative problem and often is a major consideration in the selection of therapy for clinically localized disease. The occurrence of incontinence is unpredictable and the relationship of incontinence to operative technique is unclear. We compared urinary continence in 68 consecutive patients undergoing radical prostatectomy. In 34 patients nonnerve-sparing radical prostatectomy was performed and in 34 subsequent patients a nerve-sparing operation was done. Patient age, Gleason score and stage of the tumor, and operative time were not significantly different between the groups. In the nonnerve-sparing operated group there were 4 patients (12%) with total and 6 (18%) with stress incontinence requiring absorbent pads, compared to 0 and 2 (6%), respectively, in the nerve-sparing group. The postoperative functional urethral length in the nonnerve-sparing group was 1.9 +/- 0.6 cm. (standard deviation) and in the nerve-sparing group it was 2.3 +/- 0.5 cm., which was significantly different (p less than 0.05). The peak resting urethral pressure of the nonnerve-sparing group was 35.4 +/- 14.2 cm. water and in the nerve-sparing group it was 46.5 +/- 12.3 cm. water, which also was significantly different (p less than 0.05). The study indicates that preservation of the pelvic nerves during radical prostatectomy has a major role in the functional preservation of urinary continence.

Humans↗
PubMed1989

Transurethral prostatectomy: practice aspects of the dominant operation in American urology.

In a national survey of all American urologists transurethral prostatectomy accounted for 38 per cent of the major surgical procedures performed by the respondents. They regarded the operation as complex and they believe achievement of proficiency requires that more be performed during residency training than any other urological operation. Furthermore, they assigned transurethral prostatectomy a significantly higher relative value than have medical economists doing research in the field of physician reimbursement. The effect of recent legislated congressional reductions in the allowable Medicare fees for transurethral prostatectomy is discussed along with the impact of these reductions on urological patient care and the American urologist. Practice patterns and geographic variations in the costs of transurethral prostatectomy also are considered.

Adult↗
PubMed1988

Post-prostatectomy continence in the parkinsonian patient: the significance of poor voluntary sphincter control.

A retrospective urodynamic study of 50 parkinsonian patients was done to determine the incidence and causes of post-prostatectomy incontinence. At presentation 22 per cent of the patients were incontinent. In 36 patients who underwent transurethral prostatectomy the incontinence rate was 17 per cent preoperatively and 28 per cent postoperatively. There was a clear association between normal voluntary sphincter control and urinary continence. After transurethral prostatectomy 5 of 6 patients continent preoperatively (83 per cent) who had abnormal sphincter control became incontinent compared to 1 of 24 (4.2 per cent) who had normal sphincter control. We conclude that the major risk of incontinence following prostatectomy in the parkinsonian patient is associated with lack of voluntary sphincter control.

Aged↗